Nutrition and Physical Evaluation before Liver Transplant Surgery

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1 Northwestern Memorial Hospital Patient Education ABOUT YOUR SURGERY Nutrition and Physical Evaluation before Liver Transplant Surgery If you have questions ask your doctor or nurse. You and your care team will work together to help you be prepared for liver transplant surgery. Part of this process includes an evaluation of your nutritional health and physical fitness. This brochure describes: Your Pre-Transplant Clinic evaluation Setting goals to improve your nutrition and physical condition Ways to improve your nutrition and physical health Being in the best health possible before your transplant surgery will help your recovery. By improving your nutritional and physical health, you will: Decrease your risk for infection after your transplant Increase your strength and energy Heal better after surgery Pre-Transplant Clinic Visit Your care team will work with you during your visits to the pre-transplant clinic. During your first visit to the clinic, they will check your health status with the following measurements and exams. Height and Weight We will check your height and weight at each visit. Then we can calculate your body mass index (BMI) which measures body fat based on your height and weight. The dietitian will ask you about your weight history (gains and losses). Diet You will be asked to describe your food intake from the last 24 hours (24-hour food recall). Physical Exam The dietitian will ask you questions about your health to get more information about your nutrition. They will check for: Fluid intake Swelling and fluid retention Muscle loss Gastrointestinal problems.

2 Timed Up and Go Test At each clinic visit a member of the transplant team will have you complete a timed up and go test. The timed up and go is a simple test to assess your mobility. You will be asked to start from a sitting position, stand and walk 15 feet. A physical therapist may also check your physical strength and ability based on your performance with the timed up and go test. Grip Strength At each clinic visit a member of the transplant team will test your grip strength using a dynamometer. A dynamometer is a tool that you squeeze with your dominant hand. It measures the power of your grip. Your results will give your care team a picture of your overall muscle strength. Setting Goals Nutrition Goals The registered dietitian will use these results to make a plan that will improve the quality of your diet. They will work with you to set diet and nutrition goals. This will help ensure that you get the right amount of calories and protein you need to include in your diet each day. (See Appendix 1: Nutrition Goals.) Good nutrition will help you be in the best possible health for your transplant surgery. Activity Goals The physical therapist will work with you to set activity goals that will improve your physical fitness. (See Appendix 2: Activity Goals.) Improving Your Nutrition The liver filters all of the nutrients you eat in foods and beverages. The liver also stores the energy your body needs during periods of fasting (overnight). When the liver is damaged, waste products build up in the blood and its ability to store energy is limited. It is important to follow a healthy, balanced diet because it can help manage some complications of liver disease. The following may be some of the suggestions from your registered dietitian to improve your nutrition. Your diet may be modified depending on your specific diet needs. Small Frequent Meals The goal is to eat 4 to 6 small meals a day. You can improve your nutrition by eating meals high in calories, nutrients, and protein every 2 to 3 hours. The goal is to eat 250 to 350 calories at each small meal. (See Appendix 3: 6 Small Meals Menu Sample.) Increase Protein Protein is a nutrient needed for normal growth, wound healing, and fighting infections. Eat your protein source before other items during a meal. For example, eat eggs before toast. Try to eat 10 to 20 grams of protein at each of the 6 small meals. (See Appendix 4: Food Sources of Protein.) 2

3 Increase Calories Calories give your body the fuel it needs. Foods such as carbohydrates can give you those extra calories. Some carbohydrates include: Grains (whole grain bread, brown rice, whole grain pasta) Beans (lentils, chickpeas) Starchy vegetables (winter squash, potatoes, corn, peas) Fruit (apples, grapes, oranges) Low-fat dairy products (low-fat or 1% milk; low-fat, plain yogurt) You can add extra calories to your diet through: High-calorie evening snacks A snack of 300 to 500 calories (aim for more than 50 grams of carbohydrates) will help to improve muscle mass. Enjoy a late evening snack to avoid fasting from dinner to breakfast. (See Appendix 5: Sample Snack Recipes.) Calorie-containing beverages Some people may benefit from drinking caloriecontaining beverages such as milk, 100% fruit juice, lemonade, smoothies or nutritional supplements. Talk to your dietitian to see if this option is right for you. Nutrition Drinks There are several types of nutritional drinks that can supplement your diet. Your dietitian will help you choose the ones that are right for you. Some examples include: Ensure Boost Carnation Instant Breakfast Nepro Avoid drinks with no nutritional value, such as soda, diet soda and alcohol. Limit Water During Meals To avoid feeling full, do not drink a full cup of water 30 minutes before a meal. To allow good digestion, wait 30 minutes after a meal before drinking water. Add Vitamins and Minerals Follow your doctor s advice for adding vitamins and mineral supplements to your diet. Nutritional Support If you are unable to eat or you are not eating enough, your care team may suggest tube feedings. Tube feedings can supply your body with the nutrition you need to be healthy for your transplant. If needed, your care team will talk to you about this option. Para asistencia en español, por favor llamar al Departamento de Representantes para Pacientes al The entities that come together as Northwestern Medicine are committed to representing the communities we serve, fostering a culture of inclusion, delivering culturally competent care, providing access to treatment and programs in a nondiscriminatory manner and eliminating healthcare disparities. For questions, please call either Northwestern Memorial Hospital s Patient Representatives Department at , TDD/TTY , the Northwestern Lake Forest Patient Relations manager at and/or the Northwestern Medical Group Patient Representatives Department at , TDD/TTY Developed by: NMH Kovler Organ Transplantation Center- Liver Transplant Team October 2016 Northwestern Memorial HealthCare (10/16) Nutrition and Physical Evaluation before Liver Transplant Surgery

4 Appendix 1: Nutrition Goals Current Status Current Weight Date: Current Grip Strength Current Meal Pattern Type How many meals per day Size of meals Other Current Timed Up and Go Intermediate Goals Weight Date: Grip Strength Meal Pattern Timed Up and Go Long-Term Goals Weight Date: Grip Strength Goal Men: More than 30 kg (66 pounds) Goal Female: More than 20 kg (44 pounds) Meal Pattern Timed Up and Go 4 to 6 Small Frequent Meals Calories per day Protein per day Other Goal Less Than 11 Seconds

5 Appendix 2: Activity Goals Date Up to Chair for Meals (3 times per day) Walking (30 minutes a day) Arm Exercises (number of repetitions) Leg Exercises (number of repetitions)

6 Appendix 3: 6 Small Frequent Meals Sample Meal Plan Cooked oatmeal (1 cup) Dried cranberries (1/4 cup) 2% Milk (1 cup) Whole wheat bread (1 slice) Peanut butter (1 Tablespoon) Jelly (1 Tablespoon) Baby carrots (5) Breakfast Mid Morning Meal Meal total: 350 calories Protein: 13 grams (g) Sodium: 125 milligrams (mg) Carbohydrate: 61 g Meal total: 240 calories Protein: 7 g Sodium: 225 mg Carbohydrate: 33 g Grilled chicken breast (3 ounces) Salad greens (1 cup) with 2 tsp olive oil and 1 tsp vinegar Pear (1 small) Low sodium saltine crackers (5) Swiss cheese (1 ounce) 100% grape juice (4 ounces) Baked cod fish (3 ounces) Cooked brown rice (1/2 cup) Unsalted butter (1 teaspoon) Cooked asparagus (5) with 2 teaspoons olive oil Angel food cake (1 slice) Fresh strawberries (2) Raw almond slices (2 Tablespoons) Cool-whip (2 Tablespoons) Total Daily Nutrition: Lunch Mid Afternoon Meal Dinner Later Evening Meal Meal total: 323 calories Protein: 27 g Sodium: 432 mg Carbohydrate: 27 g Meal total: 247 calories Protein: 9 g Sodium: 89 mg Carbohydrate: 32 g Meal total: 312 calories Protein: 22 g Sodium: 344 mg Carbohydrate: 26 g Meal total: 291 calories Protein: 7 g Sodium: 294 mg Carbohydrate: 42 g 1800 calories, 85 g protein, 1500 mg sodium, 220 g carbohydrates (Individual needs may vary)

7 Appendix 4: Food Sources of Protein 3 ounce serving of cooked meat or fish is about the size of a deck of cards. Food Serving Size Grams of Protein Meat Pork, Chicken, Turkey, Beef 3 ounces (cooked) 21 grams Fish Salmon, Halibut, Tuna 3 ounces (cooked) 21 grams Shrimp 3 ounces 21 grams Eggs Egg 1 large (cooked) 7 grams Egg Whites/Egg Beaters 3 tablespoons (cooked) 5 grams Dairy Milk 1 cup 8 grams Kefir 1 cup 8 grams Cheese 1 Ounce Slice 7 grams Cottage Cheese ½ cup 14 grams Yogurt ¾ cup 11 grams Greek Yogurt ¾ cup 19 grams Dried Beans/Legumes Black, Lentil, Kidney ½ cup (cooked) 7 grams Hummus 1/3 cup (cooked) 4 grams Nuts Almonds, Walnuts ½ cup 7 grams Peanut Butter 2 tablespoons 7 grams Other Protein Tofu 4 ounces 8 grams Soy Milk 1 cup 7 grams Edamame 4 ounces 11 grams Tempeh 4 ounces 20 grams Seitan 4 ounces 31 grams

8 Appendix 5: Sample Snack Recipes Blueberry Peach Smoothie* (1 serving) INGREDIENTS ½ cup frozen blueberries ½ cup frozen peach slices ½ cup plain Greek yogurt 1 tablespoon honey 1 cup milk DIRECTIONS Add all ingredients to a blender. Process until the mixture is completely smooth. If the smoothie is too thick, add additional milk. NUTRITION FACTS 370 calories 22 grams protein 165 milligrams sodium 55 grams carbohydrates No-Cook Oatmeal (1 serving) INGREDIENTS ½ cup dry rolled oats ½ cup plain Greek yogurt ½ cup milk 1 tablespoon honey 2 tablespoons chopped nuts ½ cup fresh or frozen berries DIRECTIONS In a bowl, mix oats, yogurt, milk and honey together. Cover with plastic wrap and refrigerate at least 6 hours. When ready to serve, stir in chopped nuts, berries and cinnamon. NUTRITION FACTS 475 calories 24 grams protein 120 milligrams sodium 62 grams carbohydrates * Requires a blender to prepare

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